Ticket for Outdoor Patient
| Ward No. 27 | U-PHC No. | Registration No. 00339 | Date 05/11/2019 |
| Token No | SM/19-20/2023 05/02/2020 | Serial | 030 |
| Patient Name | Mrs. MANJU DOLUI | Contact No | 8296454513 |
| Address | 34/B/19 B B GHOSH ROAD SUKANTA PALLY SERAMPORE 712203 | Age | 55 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||